Diabetes Patients and Physicians Have Different Priorities

Major Finding: Diabetes patients with multimorbidity and their physicians commonly don't agree on the relative importance of comorbid health conditions.

Data Source: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with comorbid hypertension.

Disclosures: The study was supported by the Robert Wood Johnson Clinical Scholars Program. The authors reported having no financial disclosures.

Diabetes patients with multiple health concerns and their physicians are not always on the same page regarding the relative importance of specific comorbidities, and this incongruity could have clinical management implications, according to a report by University of Michigan researchers.

In a prospective cohort study designed to assess concordance of patient and physician priorities, Dr. Donna M. Zulman and her colleagues from the University of Michigan, Ann Arbor, surveyed 92 primary care providers and 1,169 of their diabetic patients, asking the patients to rank their most important health concerns and asking the providers to rank the most important conditions likely to affect the patients' health outcomes.

For 60% of the patient-provider pairs, concordance was high, meaning that the provider ranked the same top three health concerns as the patient or that the provider ranked two of the same health concerns as the patient, and these two matched the patient's most important concerns, the authors reported. For 72% of the patient-provider pairs included in the analysis, the patient's most important concern was on the provider's top three list, but only 16% of the pairs had three matches, 55% had two matches, and 25% had one match, while 4% had no matching health concerns, they wrote (J. Gen. Intern. Med. 2010 Feb. 2 [doi:10.1007/s11606-009-1232-1

The discordance between patient and physician perception of hypertension as the most important comorbidity in diabetic patients was especially notable, according to the authors. “Although providers ranked hypertension as the most important health condition for 384 (38%) patients, only 184 (18%) patients listed hypertension as their most important health concern,” they wrote. “Patients were more likely than providers to list 'losing weight or being more active' in their top three concerns (35% vs. 21%, respectively).” This finding is consistent with previous data suggesting that many diabetic patients are not aware of the importance of blood pressure control despite the available evidence and clinical guidelines that stress its importance, the authors said.

Another striking disconnect was observed between patients who listed pain or depression as their top health concern relative to the number of their providers who ranked these conditions as likely to affect the patient's health outcomes. For example, only 9% of patients who listed pain as their top health concern had a provider who ranked it among the top three, and only 32% of patients who listed depression as their most important comorbidity had physicians who agreed, the authors reported.

“This discordance is concerning, not only because it raises the possibility that providers are unaware of the extent to which these conditions affect their patients, but also because pain and depression can be barriers to effective diabetes self-management, and (in the case of depression) may worsen glycemic control and increase the risk of mortality,” they wrote. “By deemphasizing symptomatic conditions, providers are actually neglecting some of the most important medical concerns that are likely to affect health outcomes in these patients,” they noted.

The study had several limitations, according to the authors. These include the inability of the concordance score to measure the concept of which conditions the providers thought the patients would prioritize. Another was that the patients and providers were aware that the study was looking at diabetic patients with an elevated blood pressure level at triage, thus making it more likely that hypertension and diabetes would be listed among the top three health concerns and potentially hindering the evaluation of concordance patterns among other health conditions.

Overall, the findings suggest the need for improved communication about the risks associated with comorbidities, according to the authors. Additionally, the results “reinforce the need for heightened provider recognition of patients' symptomatic conditions as well as their non-health competing demands,” they wrote, adding that future research should focus on ways to encourage and implement these practices in primary care.

Major Finding: Diabetes patients with multimorbidity and their physicians commonly don't agree on the relative importance of comorbid health conditions.

Data Source: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with comorbid hypertension.

Disclosures: The study was supported by the Robert Wood Johnson Clinical Scholars Program. The authors reported having no financial disclosures.

Diabetes patients with multiple health concerns and their physicians are not always on the same page regarding the relative importance of specific comorbidities, and this incongruity could have clinical management implications, according to a report by University of Michigan researchers.

In a prospective cohort study designed to assess concordance of patient and physician priorities, Dr. Donna M. Zulman and her colleagues from the University of Michigan, Ann Arbor, surveyed 92 primary care providers and 1,169 of their diabetic patients, asking the patients to rank their most important health concerns and asking the providers to rank the most important conditions likely to affect the patients' health outcomes.

For 60% of the patient-provider pairs, concordance was high, meaning that the provider ranked the same top three health concerns as the patient or that the provider ranked two of the same health concerns as the patient, and these two matched the patient's most important concerns, the authors reported. For 72% of the patient-provider pairs included in the analysis, the patient's most important concern was on the provider's top three list, but only 16% of the pairs had three matches, 55% had two matches, and 25% had one match, while 4% had no matching health concerns, they wrote (J. Gen. Intern. Med. 2010 Feb. 2 [doi:10.1007/s11606-009-1232-1

The discordance between patient and physician perception of hypertension as the most important comorbidity in diabetic patients was especially notable, according to the authors. “Although providers ranked hypertension as the most important health condition for 384 (38%) patients, only 184 (18%) patients listed hypertension as their most important health concern,” they wrote. “Patients were more likely than providers to list 'losing weight or being more active' in their top three concerns (35% vs. 21%, respectively).” This finding is consistent with previous data suggesting that many diabetic patients are not aware of the importance of blood pressure control despite the available evidence and clinical guidelines that stress its importance, the authors said.

Another striking disconnect was observed between patients who listed pain or depression as their top health concern relative to the number of their providers who ranked these conditions as likely to affect the patient's health outcomes. For example, only 9% of patients who listed pain as their top health concern had a provider who ranked it among the top three, and only 32% of patients who listed depression as their most important comorbidity had physicians who agreed, the authors reported.

“This discordance is concerning, not only because it raises the possibility that providers are unaware of the extent to which these conditions affect their patients, but also because pain and depression can be barriers to effective diabetes self-management, and (in the case of depression) may worsen glycemic control and increase the risk of mortality,” they wrote. “By deemphasizing symptomatic conditions, providers are actually neglecting some of the most important medical concerns that are likely to affect health outcomes in these patients,” they noted.

The study had several limitations, according to the authors. These include the inability of the concordance score to measure the concept of which conditions the providers thought the patients would prioritize. Another was that the patients and providers were aware that the study was looking at diabetic patients with an elevated blood pressure level at triage, thus making it more likely that hypertension and diabetes would be listed among the top three health concerns and potentially hindering the evaluation of concordance patterns among other health conditions.

Overall, the findings suggest the need for improved communication about the risks associated with comorbidities, according to the authors. Additionally, the results “reinforce the need for heightened provider recognition of patients' symptomatic conditions as well as their non-health competing demands,” they wrote, adding that future research should focus on ways to encourage and implement these practices in primary care.

Major Finding: Diabetes patients with multimorbidity and their physicians commonly don't agree on the relative importance of comorbid health conditions.

Data Source: Prospective cohort study of 92 primary care providers and 1,169 of their diabetic patients with comorbid hypertension.

Disclosures: The study was supported by the Robert Wood Johnson Clinical Scholars Program. The authors reported having no financial disclosures.

Diabetes patients with multiple health concerns and their physicians are not always on the same page regarding the relative importance of specific comorbidities, and this incongruity could have clinical management implications, according to a report by University of Michigan researchers.

In a prospective cohort study designed to assess concordance of patient and physician priorities, Dr. Donna M. Zulman and her colleagues from the University of Michigan, Ann Arbor, surveyed 92 primary care providers and 1,169 of their diabetic patients, asking the patients to rank their most important health concerns and asking the providers to rank the most important conditions likely to affect the patients' health outcomes.

For 60% of the patient-provider pairs, concordance was high, meaning that the provider ranked the same top three health concerns as the patient or that the provider ranked two of the same health concerns as the patient, and these two matched the patient's most important concerns, the authors reported. For 72% of the patient-provider pairs included in the analysis, the patient's most important concern was on the provider's top three list, but only 16% of the pairs had three matches, 55% had two matches, and 25% had one match, while 4% had no matching health concerns, they wrote (J. Gen. Intern. Med. 2010 Feb. 2 [doi:10.1007/s11606-009-1232-1

The discordance between patient and physician perception of hypertension as the most important comorbidity in diabetic patients was especially notable, according to the authors. “Although providers ranked hypertension as the most important health condition for 384 (38%) patients, only 184 (18%) patients listed hypertension as their most important health concern,” they wrote. “Patients were more likely than providers to list 'losing weight or being more active' in their top three concerns (35% vs. 21%, respectively).” This finding is consistent with previous data suggesting that many diabetic patients are not aware of the importance of blood pressure control despite the available evidence and clinical guidelines that stress its importance, the authors said.

Another striking disconnect was observed between patients who listed pain or depression as their top health concern relative to the number of their providers who ranked these conditions as likely to affect the patient's health outcomes. For example, only 9% of patients who listed pain as their top health concern had a provider who ranked it among the top three, and only 32% of patients who listed depression as their most important comorbidity had physicians who agreed, the authors reported.

“This discordance is concerning, not only because it raises the possibility that providers are unaware of the extent to which these conditions affect their patients, but also because pain and depression can be barriers to effective diabetes self-management, and (in the case of depression) may worsen glycemic control and increase the risk of mortality,” they wrote. “By deemphasizing symptomatic conditions, providers are actually neglecting some of the most important medical concerns that are likely to affect health outcomes in these patients,” they noted.

The study had several limitations, according to the authors. These include the inability of the concordance score to measure the concept of which conditions the providers thought the patients would prioritize. Another was that the patients and providers were aware that the study was looking at diabetic patients with an elevated blood pressure level at triage, thus making it more likely that hypertension and diabetes would be listed among the top three health concerns and potentially hindering the evaluation of concordance patterns among other health conditions.

Overall, the findings suggest the need for improved communication about the risks associated with comorbidities, according to the authors. Additionally, the results “reinforce the need for heightened provider recognition of patients' symptomatic conditions as well as their non-health competing demands,” they wrote, adding that future research should focus on ways to encourage and implement these practices in primary care.